| Objective:Through the collected over the past five years about community intervention of hypertension related literature, using meta analysis study on effects of community-based intervention on hypertension, and the data collection profile information description, to carry out a community survey, analysis and comparison at this stage hypertension community intervention way, effect and influence factors of and for the selection and optimization of community intervention of hypertension in China to provide scientific basis for Content and methods:1. Community hypertension intervention method and effect of meta analysis: in combination of the subject headings and keywords with free word retrieval strategy. Online searching the CNKI, Wanfang and VIP databases from 2009 to 2013: the community hypertension intervention literature. According to the inclusion and exclusion criteria included in the final 14 literatures in accordance with the standard. The effect of ES(ln RR) value of hypertension intervention was analyzed, and the sub group analysis of southern and northern, urban and rural areas was further analyzed.2. Effects of community-based intervention on hypertension contour information descriptive analysis: combination of the subject headings and keywords with free word retrieval strategy. Online searching the CNKI, Wanfang and VIP databases from 2009 to 2013: the community hypertension intervention literature. According to the inclusion and exclusion criteria, and ultimately into the 156 articles met the criteria in the literature. To before comprehensive intervention and after comprehensive intervention for hypertension control rate difference, awareness rate difference, the rate of taking medicine difference, behavioral improvement rate difference(smoking, drinking, salt restriction, exercise guidance, obesity, psychological guidance) as major indicators of analysis, of different interventions 7(comprehensive intervention of 1 ~ 5) according to the different region(the South and the north, the urban and rural), different intervention time(time intervention within 1 year, intervention time more than 1 year), different groups of people(population, over 60 years old population), analysis and compared the average rate, the maximum value, minimum value, 95% confidence interval, median.3. Investigation the effects of community-based intervention on hypertension in Fuzhou City: according to the stratified cluster random sampling method, using semi-structured, at two District in Fuzhou city(Gulou District, Taijiang District), two counties(Minhou County, Yongtai county) of the community health service center of health examination(the main investigation including hypertension and non hypertension patients) 、hypertension management staff in community health service centerabout effect 、 intervention way and control factors of intervention for hypertension; using semi-structured, hypertension of community intervention status, problems, opinions and suggestions etc, recording interviews of 6 experts in Fuzhou city and analysis. Results:1. The results of Meta analysis of community intervention and effect:(1) 1179 papers were retrieved from initial retrieval, and the 14 literatures were included in Meta. The 14 literature hypertension control rate differential ES(ln RR value)value combined with and analysis, the prompted data between heterogeneous test for heterogeneity(χ2=24.96, P = 0.023<0.05, I2 =47.9%), using a random effects model to combine the data. The results show that merging ES was 0.64, 95% CI(0.60 ~ 0.68), the Z test,the difference is statistically significant(Z=32.61, P < 0.01).(2)According to the South and the north of subgroup analysis, the heterogeneity test data that heterogeneity between southern, North without heterogeneity(South: χ2=16.86, P = 0.018<0.05, l2=58.5%; North: χ2=8.02, P = 0.155>0.05. I2=37.7%), respectively using random effect model and fixed effect model to calculate north and South with hypertension control rate difference. The results showed that ES in the south was 0.63. 95%CI(0.58~0.69), northern ES was 0.64, 95%CI(0.59~0.70),the Z test, compared with statistical significance(P<0.01).(3) According to the urban and rural areas to subgroup analysis, the heterogeneity test data that heterogeneity between urban, rural non heterogeneity(city: χ2=19.47,P=0.035<0.05, I2=48.6%; Rural: χ2=2.49, P=0.288>0.05.I2=19.8%)were used random effect model and fixed effect model to calculate the urban and rural hypertensive control rate difference. The results showed that urban es was 0.66, 95% CI(0.61~0.70), rural es was 0.57, 95%CI(0.49 to 0.66), the Z test,compared with statistical significance(P<0.01).(4) The publication bias of the included literature was evaluated. The results were not statistically significant(P>0.05), and there was a little publication bias.2. Effects of community-based intervention on hypertension contour information descriptive analysis results:(1) Effect of comprehensive intervention with a combination of diet, medication and exercise: the south better than the north in the smoking and drinking, North in hypertension control, medication compliance and psychological improvement is superior to the South; urban in control, smoking and drinking alcohol is better than the rural, rural shows in the results take comprehensive intervention effect best to control high blood pressure and awareness, poor for smoking and mental improvement, the average control rate difference, awareness rate difference, smoking improve rate difference, mental improvement rate difference respectively 32.47% and 33.68%, 16.95,17.71%. Hypertension awareness, medication compliance and psychological improvement rural better than the urban; intervention within one year in the limit of salt is better than intervention for more than one year, the intervention long for more than 1 year in hypertension awareness situation better than intervention when long within 1 year; in the obese improvement in the population as a whole is better than the 60 year old population, in hypertension control, know, smoking, drinking, exercise and salt restriction improvement over 60 years old man is better than that of the whole population.(2)Effect of comprehensive intervention with a combination of diet, exercise, medication and psychological: the results showed that the best effect to take comprehensive intervention to control high blood pressure and awareness, poor for smoking and mental improvement, the average control rate difference, awareness rate difference, smoking improve rate difference, mental improvement rate difference was 35.77%,34.00%, 18.62%, 18.52%. South is better than the north in hypertension awareness, smoking, drinking and salt restriction, North in obesity, psychological improvement is superior to the South; urban in smoking and drinking is better than the rural, rural in hypertension awareness, medication compliance improvement is superior to city; intervention long for more than 1 year in smoking, drinking and motion improvement is better than intervention within one year; in the population as a whole in medication compliance and drinking is better than over 60 years old and over 60 years of age in the elderly hypertension awareness, exercise, obesity improvement is better than the population as a whole.(3) Effect of comprehensive intervention with a combination of diet, exercise and psychological: the results show that adopting comprehensive intervention effect best for the hypertension awareness, poor for smoking and mental improvement, the average awareness rate difference, smoking improve rate difference, psychological improvement rate were 37.12%,17.53%, 15.40%. The south in smoking, drinking and salt restriction improved better than the north, the north in exercise, obesity and psychological improvement is superior to the South; rural in hypertensive know, medication compliance improvement is better than urban; intervention time within a year in improving psychological intervention is better than time more than one year. The duration of intervention one year above in smoking, drinking and exercise improve intervention is better than time within a year; in the population as a whole in terms of the medication, smoking, drinking, salt restriction is better than 60 years older, over 60 years of age in the elderly hypertension control, dynamic guidance, obesity is better than the population as a whole.(4)Effect of comprehensive intervention with a combination of exercise, drugs and psychological: the results show that adopting comprehensive intervention effect best to control high blood pressure and awareness, poor for smoking and mental improvement, the average control rate difference, awareness rate difference, smoking improve rate difference, mental improvement rate difference respectively 35.77%, 18.72%, 17.46%. south in smoking, drinking and salt restriction is better than the north, North in the medication compliance of hypertension, exercise guidance, obesity, and psychological guidance is better than those of the South; urban in smoking and drinking better than rural, rural 10 in hypertensive know, medication compliance improvement is better than that of the urban; intervention time one year above in smoking, drinking and exercise guidance improve the superior to the intervening time within a year; in the population as a whole in medication, alcohol better than over 60 years old, over 60 years of age in the elderly hypertension awareness, exercise guidance, obesity was better than that with population.(5) effect of comprehensive intervention with a combination of health education, medication, exercise and psychological: the results showed that to take comprehensive intervention effect best to control high blood pressure and awareness, poor for smoking and mental improvement, the average control rate, awareness rate difference, smoking improve rate difference, mental improvement rate difference was 35.77%, 35.00%,18.62%,19.52%. South awareness, smoking, drinking, salt restriction improve better than that of the north, the north in exercise hypertension guidance, obesity, and psychological guidance is better than those of the South;urban in smoking and drinking better than rural, rural in hypertensive know, medication compliance improvement is better than that of the urban; intervention time for more than a year in hypertension awareness, smoking, drinking and exercise improve is superior to the intervention time of one year or less; population in medication, alcohol is better than the above 60 years old and over 60 years old people in hypertension awareness, exercise, and obesity improvement is better than the population as a whole.(6) Take comprehensive intervention to improve the best known rate, poor as smoking and drinking to improve the situation in the South; smoking is better than the north, the northern limit the improvement of salt and psychological guidance is better than the South City; in smoking, drinking, exercise, obesity, salt restriction improvement and psychological guidance were better than those in rural areas, the rural hypertension awareness to improve the situation better than the city; the intervention time within a year in hypertension psychological guidance is better than intervention for more than a year, more than a year in the intervention of hypertension control, awareness, medication better than intervention time within a year; the whole population in medication, alcohol is better than 60 above the crowd, people over the age of 60 in the control of hypertension, smoking, drinking, exercise guidance, salt restriction, obesity and psychological guidance is better than the whole population.3. Fuzhou city community hypertension intervention survey results:(1)Urban residents and rural residents,patients and non patients, community residents and community workers of hypertension intervention effect evaluation, by chi square test(χ2 were 3.047, 1.339,1.442), the difference was not statistically significant(P > 0.05).(2)Urban residents and rural residents,patients and non patients, community residents and community workers of hypertension intervention evaluation methods are inconsistent, the chi square test(χ2 respectively 54.182,14.610,22.781), the differences were with statistical significance(P<0.05).( 3) Main effects on hypertension prevention and control factors of urban residents and rural residents is different, urban residents believe that the main influence factor is lifestyle(95%), intervention(68%) and intervention intensity(66%), rural residents that the main influence factors is a way of life(85%) and age(62%), by chi square test, and the difference is statistically significant(χ2=38.497, P < 0.05); patients and non patients, community residents and community workers for hypertension prevention and control of the main influence factors about the overall agreement, the chi square test(χ2=2.996, 9.137), the differences were no statistical significance(P >0.05).(4)Community residents and community work personnel of community hypertension intervention effect says yes, think their hypertension awareness and behavior to improve the situation have been improved to some extent, in the prevention and cure of hypertension most want to get better support and help in health education, medication guidance, psychological guidance, medical insurance. The relevant experts believe that taking the hypertension community intervention way is effective, and put forward some suggestions and optimization strategy for the problems. Conclusions:1.The overall effect of hypertension community intervention in China is positive, and the effect of the intervention is different from the South and the north, the urban and the rural, the different people and the different intervention time2.The effect of different hypertension community intervention(diet, exercise, medicine, psychology and health education) on the hypertension intervention may not be the same.3. Take the same community hypertension intervention in different regions(North and South), different regions(urban and rural) and different time(within a year and more than one year), different groups of people(the whole population and over 60 years old) effect may not be consistent. Suggestion:The comprehensive intervention measures for the community of hypertension were actively implemented, and according to the specific circumstances(different regions, different people, different intervention time, etc.), the different interventions were optimized and selected.;... |
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